Prelim Research Project. David Hillel Rosmarin, MA Spring, 2006

Transcription

1 Prelim Research Project Trust in God, anxiety and depression: an initial investigation into the validity of an ancient Jewish psychological theory David Hillel Rosmarin, MA Spring, 2006 Committee: Kenneth I. Pargament, PhD, Advisor Annette Mahoney, PhD John Tisak, PhD Timothy Murnen, PhD

2 1 Table of Contents Table of Contents... 1 Acknowledgments... 4 Introduction... 7 Literature Context... 8 Psychology and Religion A Brief Overview... 8 Religion and Depression Religion and Anxiety Psychological Literature on Orthodox Judaism Psychometric Scales and Judaism An Ancient Jewish Psychological Theory The Author and the Text The Theory What is Trust in God? Congruence with Cognitive Theory The Present Study Method Participants The Research Questionnaire Items to Measure Trust in God Demographic and General Religiousness Items Measures of General Mental Health Penn State Worry Questionnaire Center for Epidemiological Studies Depression Scale Depression Anxiety Stress Scale (21-item version) Subjective Happiness Scale Additional Measures Stressful Life Events Deferring Religious Coping Narcissism Self-Respect Procedure Results Creation of the Trust in God Scale Reliability of the Trust in God Scale Internal Consistency Test-Retest Reliability Validity of the Trust in God Scale Content Validity Construct Validity Concurrent Validity An Initial Test of Rabbi Bachaya s Theory Control Variables Trust in God and Psychological Well-being Additional Analyses... 45

3 Trust in God and Psychological Well-being across Religious Affiliation Trust in God and Deferring Religious Coping Trust in God and Narcissism Trust in God and Self-Respect General Jewish Religiousness and Psychological Well-being Discussion Reliability and Validity of the Trust in God Scale Reliability Validity The Testing of Rabbi Bachaya s Theory Limitations & Future Directions References Appendix A Excerpts from The Gate of Trust in God Relevant to Anxiety and Depression English adapted from text by David Hillel Rosmarin; page numbers correspond to Ibn Pekuda, B., Appendix B Appendix C The Trust in God Item Pool Appendix D Demographic, General Religiousness and Other Items Appendix E Measures of Psychological Wellbeing Penn State Worry Questionnaire (PSWQ) Center for Epidemiological Studies Depression Questionnaire (CES-D) Depression Anxiety Stress Scale (DASS) 21-item Subjective Happiness Scale Appendix F Additional Measures Narcissistic Personality Inventory Exploitiveness/Entitlement Scale Self-Respect Scale Deferring Coping Scale Stressful Life Circumstances Appendix G Invitation Appendix H Consent Form Appendix I Thank You Page Table Table Table Table Table Table Table

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5 4 Acknowledgments It s been almost seven years since my teacher Rabbi Nissan Applebaum introduced me to the psychological wisdom of Rabbi Bachaya Ibn Pekuda s Duties of the Heart. As such, my line of research on Trust in God is largely to his credit; this project simply would not have happened without him. Over the years, Rabbi Applebaum has continued to be a source of guidance to me, both personally and professionally. In addition, he diligently reviewed and commented on the research materials for this study, providing invaluable feedback. Words cannot express my gratitude to Rabbi Leib Kelemen. Since our first encounter in July 2000, Rabbi Kelemen has been a constant source of inspiration, direction, and personal support to me and my family. I would never have considered embarking on this project without his care, and I am eternally indebted to him. I am also most grateful to Rabbi Shmuel Irons, who dedicated several hours of his time to this project. Rabbi Irons provided guidance about the methodology of this study that proved essential for its completion. I was also very privileged to learn from him about the interface of Jewish religious thought and modern psychology. I hope to be fortunate enough to have his assistance on future studies. Professor Ken Pargament took me on as his student at Bowling Green State University in August, Since that time, I have been most privileged to access his superior wisdom about the psychology of religion, research methodology and statistical analyses. Ken guided me all the way through the grueling details of this study from day one through its fruition. It is my hope that we will continue to work on many more projects together, enhancing the knowledge base about this important subject. I am also

6 5 grateful to my committee members, Professors Annette Mahoney and John Tisak for providing feedback and guidance at several stages of this project s development. I was privileged to have an exceptionally talented editorial team for this study comprised of Dr. Daniel Goldenholz, Professor Milton Houpt, Racquel Houpt, Dr. David Moscovitch, Alex Neuman, Naomi Roskies, Professor Ethel Roskies, and my sister Caren Richards. These individuals meticulously reviewed and commented on my written materials at the early stages of this project, shaping the final product in a myriad of ways. I am very thankful for their assistance. Shoshana Zakar was responsible for the set-up of the internet based survey used in this study, as well as the entire website. She was, and continues to be, a pleasure to work with, and I thank her for her exceptional diligence, patience and talent. Additionally, thanks go to my colleagues Elizabeth Krumrei, Kelly Lister, Kelly McConnell and Amy Wachholz for their comments while the internet based survey was being constructed. There is no greater blessing than exceptional teachers, and so I am very thankful to Rabbi Dr. Efraim Becker, Rebbetzin Chaya Bloomenfield, Rabbi Dr. Gerry Lob, Rabbi Zelig Pliskin, Rabbi Dr. Akiva Tatz and Rabbi Dr. Abraham Twerski for their personal consultation about this study. I have learned an immense amount from them about the relationship between Jewish religious belief/practice and psychological wellbeing. I am also thankful to Dr. Norman Goldwasser, and NEFESH, the International Network of Orthodox Mental Health Professionals, for providing me with opportunities to present excerpts from this research in a public forum.

7 6 Living in Toledo, OH is not an easy task for Orthodox Jewish family. As such, I am most grateful to Rabbi and Rebbetzin Yehuda and Sarah Garsek for their incessant efforts to make Toledo Jewish life vibrant. I am also very grateful to Mr. and Mrs. Gary and Malke Torgow and their wonderful family, for providing me with a home away from home in Oak Park, Michigan. Were it not for these precious individuals, I would have given up on this project long ago! I am especially grateful to my parents Mr. And Mrs. Ian and Pam Rosmarin for providing me with the guidance, love and financial support necessary for me to complete this project and my PhD. They are the most wonderful parents I could ask for. I am also thankful to my children Yehuda Avraham and Bina for keeping my evenings lively and ensuring that there is never a dull moment. Finally, and most of all, I am eternally grateful to my wife Miri for believing in me, challenging me, and guiding me every day. Aside from being the world s most calm and patient wife and mother, Miri was consulted more than anyone else about this project and in reality we share its authorship.

8 7 Introduction Approximately one thousand years ago, Rabbi Bachaya Ben Yoseph Ibn Pekuda (henceforth Rabbi Bachaya), an acclaimed leader of the Spanish Jewish community in his time, wrote his most famous treatise Duties of the Heart. Originally written in Arabic and subsequently translated into Hebrew, Spanish, Portuguese, Yiddish, German, French and English, Duties of the Heart has been studied extensively in religious Jewish communities since it was written, and has been described as one of the most important contributions of all medieval Jewish philosophy (Ibn Pekuda, circa 1080/1973). The text is best known for its elucidation of Jewish philosophical principles as they apply to human emotion and thought (Ibn Pekuda, 1080/1970). As such, it has been observed that many sections from the text are relevant to human psychology (Ibn Pekuda, 1080/1996a). In particular, the fourth section of the text, dubbed The Gate of Trust in God, is highly relevant to the study of modern psychology. In it, Rabbi Bachaya puts forth a theory of the etiology of human anxiety and depression, stating that the multi-faceted construct Trust in God is directly related to psychological wellbeing (Rosmarin, 2001). The present study is an initial empirical investigation of the validity of Rabbi Bachaya s ancient theory, with a large and religiously diverse Jewish community sample (N = 567). Additionally, while the past several years have seen a great increase in the number of psychological studies concerned with religion (Hall, Tisdale and Brokaw, 1994), psychological knowledge about the Jewish religion is still lacking. To date, an empirical analysis of the relationship between religious Jewish beliefs and psychological variables among Orthodox Jews has yet to be a published. Furthermore, the potential for research on this subject is limited as few modern psychometric instruments have been developed

9 8 to measure Jewish spirituality and/or religiousness. The present study attempted to address these limitations by creating the Trust in God Scale, a self-report instrument which can be used to measure the Jewish religious construct Trust in God. It is hoped that the Trust in God Scale will help to increase the epistemic place of Jewish religiousness within the context of psychological empirical inquiry, and hence be utilized to shed much needed light on the relationship between Jewish religiousness and psychological wellbeing. Literature Context Psychology and Religion A Brief Overview Throughout most of the past century, the subject of religion was a relatively unresearched topic in the field of psychology. In the late 19 th century, the first American psychologists devoted much of their pioneering efforts to study the psychology of religion, however from the early 20 th century to the 1960 s this topic became largely dormant (Donelson, 1999). This shift in attention may be partially attributed to the alienation which existed between the fields of mental health and religion during this period (Richards and Bergin, 2000). Hostile spirits towards religion in Freudian thought, and the mechanistic and atheistic assumptions embedded in Watson s behaviorism certainly contributed to the development of this rift (Donelson, 1999). The following statement regarding psychological treatment of religious clients, articulated by of one of the 20 th century s most prominent psychologists, is a prime example of this alienation. I choose, rather, to show them, in most instances, that what they call their religious beliefs are totally incompatible with a good state of mental health and emotional well-being and that, whether they like it or not, they are going to have to become less religious if they are to become healthier ( An Impolite Interview with Albert Ellis, 1960, The Realist).

10 9 The negative attitude of many psychologically minded individuals towards religion has softened considerably in recent years (Richards and Bergin, 2000), perhaps in part due to the increase in psychological research concerned with religion (Hall, Tisdale, and Brokaw, 1994). The majority of research studies in this area have found that religious variables are commonly associated with positive psychological and physical health (Gartner, 1996; Levin, 1996; Koenig, 1997; Larson, Swyers & McCullough, 1997; Ellison, Boardman, Williams & Jackson, 2001; Koenig and Larson, 2001). Religiousness has also been shown to be a highly salient component of coping with life struggles (Pargament, 1997). In the past 15 years, considerable evidence has linked religiousness to increased levels of psychological well-being (Ellison, 1991; Levin, Chatters & Taylor, 1995; Thomas & Holmes, 1992). As Ellison et al. (2001) state, Perhaps the largest body of evidence regarding salutary religious effects involves psychological well-being (e.g., life satisfaction, happiness, and morale). Nearly all published studies show that multiple dimensions of religious involvement are positively related to well-being (p. 215). Other researchers have demonstrated significant relationships between religious participation/affiliation and decreased levels of risk-taking behavior including the use of alcohol, tobacco & drugs (Cochran, Beeghley & Bock, 1988; Koenig, George, Meador, Blazer & Ford, 1994; Koenig, George, Cohen, Hays, Larson & Blazer, 1998). In 1995, a meta-analysis of data based on information provided by a nationally selected sample of N=34,129 adolescent respondents concluded that simple measures of religiousness could significantly predict lower suicidal ideation, alcohol use, marijuana use, tobacco use, and violence, as well as higher altruistic values, altruistic behaviour, and self esteem (Donahue and Benson, 1995). It has also been reported that religiousness is positively associated with family cohesiveness (Mahoney, Pargament, Tarakeshwar, & Swank, 2001). As stated by Weaver, Samford, Morgan, Larson, Koenig and Flannelly (2002),

11 10 there is increasing evidence that for a significant number of people commitment to a faith community can enhance family life and marital stability (p. 294). In a number of studies, religion has also been emerged as an important resource to individuals experiencing stressors and traumas (Pargament, 1997). Religion and Depression Of particular interest to this study is the relationship between religiousness, depression and anxiety, and a number of studies have been conducted in this area. With respect to depression, Smith, McCullough and Poll (2003) conducted a meta-analysis of 147 independent investigations into the relationship between religiousness and depressive symptomatology. Across all studies, the correlation between religiousness and symptoms of depression was r =.096, indicating that greater religiousness is mildly associated with lower levels of depression. The authors note that the association between religiousness and depression varied considerably across types of religiousness measured. For example, amongst studies of religious behavior and depression, the correlation between religiousness and depression was r =.124, while this figure jumped to.199 amongst studies of God concepts and depressive symptoms. Furthermore, studies of extrinsic religious orientation and negative religious coping indicated positive associations between religiousness and depression (r =.155 and r =.136, respectively). Therefore, while the general trend in the literature indicates that increased religiousness is associated with lower levels of depression, the specificity of religious variables measured may play a large role in determining the relationship between these two variables. While very little research has been conducted on possible mechanisms of association between religiousness and depression, some researchers have attempted to

12 11 isolate the relationship between these variables by controlling for other known correlates of depressive symptoms. For example, in 2004, a group of researchers from the southern United States examined the extent to which religiousness was able to predict levels of depression, after controlling for race, gender, social support, income sufficiency and physical health. Using data collected from in-home interviews with 1000 adults aged 65+, it was found that highly religious persons had lower levels of depression, even after controlling for other known covariates, β =.16, p <.001 (Roff, Klemmack, Parker, Koenig, Crowther, Baker & Allman, 2004). Other studies have looked at how religiousness is related to the likelihood of suicide amongst depressed individuals. In 2004, Dervic, Oquendo, Grunebaum, Ellis, Burke and Mann, investigated the association between religion and suicide in a depressed inpatient sample (N=371). The researchers identified a number of salient clinical characteristics that distinguished inpatients who reported belonging to a specific religion from those who described themselves as having no religious affiliation. Religiously affiliated subjects had significantly fewer lifetime suicide attempts, fewer first-degree relatives who committed suicide, more perceived reasons to live, and a greater tendency to morally object to suicide. They also exhibited lower levels of lifetime impulsivity, aggression and past diagnoses of substance abuse. Some inquiries have demonstrated that the relationship between religiousness and depression may not be linear. One recent study analyzed data from a large epidemiological survey of 70,884 Canadian respondents to determine the relationship between attendance of religious services, religious self-perception, and importance of religion to depressive symptomatology, while controlling for demographic, social and health variables (Baetz, Griffin, Bowen, Koenig, & Marcoux, 2004). A regression

13 12 analysis revealed that frequent attendance at religious services was associated with fewer depressive symptoms. However, individuals who perceived themselves as religious and/or viewed religion as being of importance in their lives had higher levels of depression than their irreligious counterparts. Other researchers have found that the relationship between religiousness and depression is curvilinear in nature (Ross, 1990), and that those who strongly believe in their religion and those who reject all religious belief have relatively low distress scores. Religion and Anxiety The relationship between religiousness and anxiety is still unclear in the current literature for a number of reasons. First, while the past two decades have seen a significant increase in psychological studies about religion, the relationship between religiousness and human anxiety remains an understudied topic (Shreve-Neiger & Edelstein, 2004). Second, the majority of studies conducted on the subject of religiousness and anxiety have utilized crude indices of religiousness such as single-item measures of religious observance, rather than more complex religious constructs (Pargament, 2002). Most important, however, the existing literature on this subject indicates that religiousness is both positively and negatively associated with anxiety. The following are some select examples of current studies. Working with 760 women in the midwestern United States, Hertsgaard and Light (1984) administered the Multiple Affect Adjective Check List (Zuckerman, Lubin & Rinck, 1983) as well as a series of demographic items including a single religiousness item. More-than-monthly church attendance was a significant predictor of lower anxietysubscale scores, leading the authors to conclude that church attendance may be a factor

14 13 that mitigates anxiety among rural females. A similar study was conducted by Williams, Larson, Buckler, Heckmann, and Pyle (1991), using data from a two-part longitudinal mental health study conducted in the late 1960 s with 720 participants. Regression analyses revealed that a single item asking respondents to rate the frequency of their church attendance in one of three categories ( high 1x/wk or more; moderate 1-3x/month; and low a few times a year or never) was a significant predictor of scores on the Symptom Checklist Scale (Gurin, Veroff, & Feld, 1960); higher levels of church attendance were associated with lower levels of anxiety sub-scale scores. In an Israeli study, Zeidner and Hammer (1992) measured religious activities, spiritual resources and state anxiety in a survey study of 261 Jewish participants during the Gulf War in a region threatened by missile attacks. After controlling for other known correlates of anxiety in the regression model, the researchers found that religious behavior was correlated with increased levels of anxiety (r =.33, p<.05), as were other spiritual resources (r =.20, p<.05). The investigators concluded that religious individuals were more likely to perceive war as a threat to religious culture and values, which in turn increases the likelihood of anxiety. While this conclusion proposes that religiousness can lead to the development of anxiety, it is possible that the results of Zeidner and Hammer s study indicate that the stress of war lead participants to turn to religion for comfort (Koenig, McCullough and Larson, 2001). A more recent paper linked religiousness to recovery from Post Traumatic Stress Disorder (Exline, Smyth, Gregory, Hockemeyer & Tulloch, 2005). In this experiment, fifteen individuals with posttraumatic stress disorder (PTSD) wrote about their PTSDtriggering traumas over three sessions. It was found that participants who used religious

15 14 framing to describe their traumas reported elevated levels of anxiety after the first writing session, when compared to participants who did not use religious framing. However, by the third session religious framing was associated with decreased levels of anxiety whereas nonreligious framing was still associated with nervousness and distress. Several other studies have suggested that religious beliefs and practices may be especially helpful for individuals who are dealing with highly stressful life events (Pargament, 1997). Other researchers have found that intrinsic religiousness has a markedly different relationship to anxiety than extrinsic religiousness. For example, Baker and Gorsuch (1982) conducted a survey study with 52 participants in California using measures of intrinsic-extrinsic religious orientation and trait anxiety. Anxiety was found to negatively correlate with intrinsic religiousness (r = -.33, p<.05) but to positively correlate with extrinsic religiousness (r =.35, p<.05). A negative correlation between intrinsic religiousness and anxiety and a positive correlation between extrinsic religiousness and anxiety has been confirmed in several other studies (e.g. Sturgeon and Hamley, 1979; Bergin, Masters and Richards, 1987; Tapanya, Nicki and Jarusawad, 1997). This body of research may help to explain the mixed findings regarding how religion is related to anxiety (Koenig, McCullough and Larson, 2001). The above review of the current literature on religion and anxiety indicates the need for increased psychological study on this topic. First and foremost, there appears to be a lack of research on the subject of religiousness and anxiety. This may be partially attributable to the multi-faceted nature of human anxiety; the DSM describes no less than 11 different types of Anxiety Disorders including Panic Disorder, Posttraumatic Stress Disorder, Social Phobia, Specific Phobia, Agoraphobia, Generalized Anxiety Disorder

16 15 and Obsessive-Compulsive Disorder. It may be further attributable to the multi-faceted nature of human religiousness. More important, the current findings are ambiguous. While some studies indicate that religiousness acts as a buffer against anxiety, other researchers have suggested that religiousness is associated with increased levels of anxiety. Furthermore, of the studies which have found religiousness to be associated with anxiety, the direction of causation is unclear; does religion lead to anxiety and guilt or is anxiety a stimulus for prayer and religious activity? While the current literature base has begun to pave the way for future investigations about this topic, it appears that more research on the relationship between religiousness and anxiety must be conducted before conclusions about this subject can be made. Psychological Literature on Orthodox Judaism The overwhelming majority of recent psychological investigations into religion have been conducted exclusively with Christian subjects. This may be attributed to the fact that Christianity is the dominant religion in regions of the world where psychology is practiced and researched (Fiala, Bjorck and Gorsuch, 2002). As a result, however, current psychological knowledge about religious Jewish populations is lacking. A recent Psycinfo search was able to locate less than 160 published journal articles with empirical and/or theoretical contributions related to Orthodox Jews, with only a single example appearing in a journal published by the American Psychological Association. Moreover, only 81 of these sources were published in the past 10 years, and very few of these publications describe the results of empirical investigations. The absence of psychological literature about Orthodox Jews is somewhat ironic, for religious Jewish sources have been concerned with mental illness and mental health

17 16 for, literally, thousands of years. Many excerpts from the Hebrew Bible, the Babylonian Talmud and the Jerusalem Talmud strive to define, evaluate, determine the causes of and suggest cures for mental illness (Hes and Wollstein, 1963). While these early sources were concerned particularly with hallucinations, delusions, and psychotic episodes (Hes and Wollstein, 1963), many medieval Jewish philosophers made significant theoretical contributions to Jewish thought on psychological issues such as marital stability and family cohesiveness (Pliskin, 1998), child-rearing and education (Kelemen, 1999) and anxiety and depression (Luzzato, 2004; Ibn Pekuda, 1996b). A more recent work by Rabbi Menachem Mendel Levin in the early 19 th century, entitled An Accounting of the Soul (1995) details Jewish philosophical beliefs about human cognition and the process for human cognitive development, which is a major area of modern psychological study. More importantly, this text describes a process of improving one s character that bears a striking resemblance to modern psychotherapeutic techniques. Rabbi Levin encourages the use of charts in daily monitoring of destructive character traits, which bares a resemblance to some techniques employed by Beck s Cognitive Therapy (1995) and Barlow s Behavior Therapy (Craske, Barlow & O Leary, 1992). The most prevalent topic in the psychological study of religious Judaism has been the experience of Orthodox Jews in psychotherapy. For example, Heilman and Witztum (1997) discuss the cultural and religious differences between Ultra, Modern and Hassidic Orthodox Jews as they apply to counseling in Israel. This source provides basic information about religious Jews which is undoubtedly helpful for psychologists working with this population. Other papers have discussed the need for same-sex therapists in accordance with the beliefs of some religious Jews (Margolese, 1998),

18 17 stigmas associated with seeking mental health services in religious Jewish communities (Paradais, Friedman, Hatch and Ackerman, 1997), and the potential need to collaborate with rabbis and/or family members in the therapy process (Greenberg, 1991). There seems to be a consensus in the literature that, in general, it is difficult for Orthodox Jews to engage in psychotherapy. Heilman and Witztum (1997) stress the importance of being aware of the fear experienced by many Orthodox Jews in entering therapy as well as the need to remain culturally and religiously sensitive throughout the therapeutic process when dealing with this population. Other authors, such as Margolese (1998), have described the generally negative attitude of members of this community towards the field of mental health. However, despite these recent contributions and the recognition in the current literature that there is a need for increased understanding of this subject matter, no empirical studies have yet been published in mainstream psychology journals about this topic. Additional psychological works concerned with Orthodox Jews have included a number of investigations into alcohol use in this community (Haines, 1992; Flasher and Maisto, 1984; Glassner and Berg, 1984). Others have examined specific cultural and ritual practices of Orthodox Jews, such as sexual behaviour (Rockman, 1993), arranged marriages (Rockman, 1994), single-gender schooling (Sloan, 2001) and religious intensification the process by which Jewish individuals become more religious (Roer- Streir and Sands, 2001). Additionally, a few theoretical articles have been published concerned with the relevance of religious Jewish beliefs to psychological wellbeing (Zedek, 1998; Hes and Wollstein, 1963). However, an empirical investigation about the relevance of Jewish religious beliefs to psychological variables has yet to be published.

19 18 Psychometric Scales and Judaism In a recent systematic review of 20 th century literature on religion and mental health, Koenig (2001) found 630 empirical sources devoted to the study of religion from a psychological framework. Much of this literature has been made possible by the creation and popularization of psychometric scales designed to measure religious constructs; such scales make it possible to evaluate the relationship of psychological variables to religiousness and spirituality (Hall, Tisdale, and Brokaw, 1994). While recent years have seen the development of several psychometric instruments capable of measuring religious constructs, most current measures of religiousness are not suitable for use with religious Jewish populations. Most of the religiousness and spirituality measures that exist today were designed for use with members of Christian populations (Moberg, 2002). As such, the majority of established scales employ Christian language in the phrasing of scale items and base operational definitions of religiousness on Christian doctrine or religious-philosophical concepts. From a research methods perspective, there are three reasons why many established psychological measures of religiousness/spirituality are problematic for use with religious Jewish populations. The first and simplest of these reasons relates to the use of religion-specific language. For example, the words church, priest and Sunday are used throughout all available versions of the Intrinsic Religious Motivation Scale (Allport and Ross, 1967; Hoge, 1972; Maltby, 1999), and the Religious Support Scale (Fiala, Bjorck, and Gorsuch, 2002). As such, these measures are not suitable for non- Christian populations. Some might argue that the difficulties involved in using established scales which employ non-jewish language with Jewish populations could be

20 19 resolved by simply replacing Christian terminology with Jewish vernacular (e.g., church synagogue; priest rabbi; Sunday Sabbath/Shabbat). However, prior to utilizing any revised measure in research, norms for the revised scale as well as statistical reliability and validity would have to be re-established and re-standardized with a sample of Jewish subjects. It would further be necessary to perform a confirmatory factor analysis to ensure that the re-worded scale s factor structure remains similar to that of the original scale. It should be noted that cultural differences have been found to have a significant impact on the factor-structure of some religious scales, and this may impose severe limitations on the adaptability of religiousness scales to certain religious-cultural populations (Miller, Fleming, and Brown, 1998). The second reason why many modern religiousness/spirituality measures are not suitable for use with religious Jewish populations is that many scales measure religious observances in accordance with non-jewish religious doctrine and practice. Some operational definitions of religiousness used in existing studies would likely yield ceiling or floor effects, or demonstrate little variability if they were to be used with religious Jewish participants. For example, Merrill, Salazar, and Gardner (2001) conducted a study on Mormon students at Brigham Young University concerning the relationship between religiousness and drug use. As a part of the measure of religiousness used in this study, students were asked the question How often did your family attend church services? with responses ranging from weekly to not at all. While this set of response options may be appropriate for Christian subjects, it would be unsuitable for use with religious Jews, as according to Jewish religious law Jewish males aged 13 and older are mandated to participate in three prayer services each day (Donin, 1972), and it is

21 20 preferable that this be done in a communal setting (Meiselman, 1978). To complicate matters further, religious Jewish practice is markedly different for females; Biale (1984) states, Women pray mostly at their own times and in private (p. 21). Consequently, were a sample of Orthodox Jews to be asked the question How often did your family attend religious services? with response options ranging from weekly to not at all, this item would be likely to produce biased results depending on the gender of the participants, and it would consequently not be an accurate reflection of participants religiousness. The third reason why many established measures of religiousness and spirituality are not suitable for use with Orthodox Jewish populations is that many such scales assess religious constructs which are not relevant or applicable to Judaism. This limitation is described in general terms by Moberg (2002) who states that many spirituality measures presume their interpretations of spirituality apply universally to all humanity when in fact they are based upon the evaluative criteria of only particular groups (p. 47). For example, the distinction between intrinsic and extrinsic religious orientation, perhaps the most widely research topic in the psychology of religion (Kirkpatrick & Hood, 1990; Masters, 1991), is fundamentally influenced by a modern individualistic perspective which values personal and unceremonious religious expressions over communal and ritual observances (Cohen, Hall, Koenig and Meador, 2005). It appears that this perspective may have arisen out of early 20 th century Protestant Christian thinking. As noted by Cohen, et al., social integration and ritual practice share equal footing with personal religious beliefs and values according to Jewish philosophy. By emphasizing the importance of ritual and religious social connectedness, Jewish religious orientation

22 21 and motivation may be extrinsic, yet no less religious from a Jewish philosophical framework. Yet, assessment of Jewish religiousness with any version of the Intrinsic Religious Motivation Scale (Allport and Ross, 1967; Hoge, 1972; Maltby, 1999) would fail to capture this aspect of Jewish religiousness. An Ancient Jewish Psychological Theory As stated above, the present study conducted an initial empirical investigation into the validity of a medieval Jewish psychological theory. In his text Duties of the Heart, Rabbi Bachaya asserts that the Jewish religious construct Trust in God is a protective factor against human anxiety and depression. The following section attempts to introduce the text Duties of the Heart and briefly explain Rabbi Bachaya s theory. The Author and the Text Rabbi Bachaya lived in Spain during the late 11 th century and practiced as a Jewish court judge, but he is most famous for writing Duties of the Heart (Ibn Pekuda, 1996b). The book was originally written in Arabic, but it has subsequently been translated into Hebrew, Spanish, Portuguese, Yiddish, German, French, and English (Ibn Pekuda, 1973). While the exact year of publication is not known (Rabbi Shmuel Irons, personal communication, September, 2004), some have estimated that the book was written around the year 1080 (Ibn Pekuda, 1973). The text has been described as one of the most popular and influential works in the whole of medieval Jewish thought (Katz, S., 1976, p. 215) and as having a profound influence on all subsequent Jewish pietistic literature (Nahmad, 1975, p. 200).

23 22 Duties of the Heart is a distinctive Jewish religious text. While most early medieval Jewish philosophers stressed the role and purpose of Jewish law/doctrine and the obligations set upon human actions Duties of the Heart details the principles of Judaism as they apply to the inner self (Katz, S., 1976). As such, it is a repository of virtuous attitudinal and intellectual qualities which Jewish philosophy encourages (Ibn Pekuda, 1996a). The text is divided into 10 chapters each of which is devoted to one of the following inner qualities (free translation): (1) The Intellectual Recognition of the Oneness of God; (2) Recognition of God s Grace to Human Beings; (3) The Attitude of Serving God; (4) The Attitude of Trusting in God; (5) The Attitude of Being Devoted to God in All of One s Actions; (6) The Attitude of Humility; (7) Repentance; (8) Self- Accounting and Reckoning; (9) The Attitude of Self-Restraint and (10) The Attitude of Love for God. Each of these qualities is presented in the context of Jewish spiritual development (Rabbi Leib Kelemen, personal communication, April, 2005). It has been suggested that a large part of Duties of the Heart is relevant to modern psychological study (Ibn Pekuda, 1996a). By detailing the principles of Judaism as they apply to the inner self, Rabbi Bachaya s Duties of the Heart is, in essence, a religious psychological treatise. However, the fourth chapter of the book, entitled The Gate of Trust in God, is particularly salient for study under the lens of contemporary psychology. The Theory Rabbi Bachaya conveys his theory about how Trust in God is related to anxiety and depression in a number of statements in the Gate of Trust in God. Please see Appendix A for a complete list of excerpts from the text which are relevant to psychological wellbeing. In the introduction to the section, he discusses the impact of

24 23 Trust in God on anxiety. He states (free translation), The benefits of trusting in God include a heart at rest without worldly concerns and worries and general calmness and tranquility (Ibn Pekuda, 1998, p. 303). Further on, Rabbi Bachaya discusses Trust in God and its relation to happiness and depression; Another benefit of trust in God is happiness in all of life s situations (p. 318). So it may be said that according to Rabbi Bachaya, Trust in God is a protective factor against human anxiety and depression, and that therefore those who have Trust in God will be tranquil and happy. Conversely, according to Rabbi Bachaya s theory, one who lacks Trust in God is at risk for developing psychological distress. He writes, One who does not trust in God is exceedingly distressed about the suffering that could befall him during his lifetime, and about what he lacks socially and monetarily (p. 398). Throughout the text, Rabbi Bachaya also explains the theoretical relationship between Trust in God and psychological wellbeing. He states, One who trusts in God feels tranquil and at peace in times of misfortune because he believes that God is taking care of life s events in accordance with his best interests (p. 392). In other words, according to Rabbi Bachaya, when people have complete faith that God is actively involved in life events, they develop confidence that all of their personal experiences, both pleasant and unpleasant, are in their best interests. As a result of this faith, any anxiety and sadness associated with unfortunate events can be mitigated by maintaining the belief that the event it essentially beneficial (i.e. trusting in God). However, one who lacks Trust in God may perceive a life struggle as a genuine impediment to his/her personal wellbeing and it is likely that this will result in anxiety and depression. As such, according to Rabbi Bachaya s theory, when an individual experiences a personal

25 24 hardship, his/her mental states become a function of Trust in God; Anxiety and frustration associated with worldly matters is caused by a lack of awareness about God s knowledge (Omniscience), God s domination over the world (Omnipotence), and God s kindness (Omnibenevolence) (p. 331). What is Trust in God? For over two thousand years, the term Trust in God has been used by religious Jewish thinkers to refer to a sense of security due to the wholehearted belief that God takes care of human best interests at all times and in all situations. The Hebrew word for Trust in God is בטחון (Bitachon), which is usually translated into English simply as reliance or security. However, Rabbi Bachaya s definition of this religious Jewish construct is considerably detailed. In the text, Trust in God is described as a constellation of six specific beliefs about God. These are: (1) God has constant regard for all worldly affairs (2) God has absolute knowledge of what is in people s best interests (3) No power is greater than God (4) God must be involved for anything to occur (5) God is merciful and generous (6) God is just in judgment It should be noted that these six beliefs can be conceptualized in three distinct categories. The first two beliefs are concerned with God s knowledge (omniscience), the next two beliefs are concerned with God s strength/power (omnipotence), and the final two beliefs are concerned with God s kindness and justice (omnibenevolence). Please see Appendix B for a list of excerpts from the text of the Gate of Trust in God in which Rabbi Bachaya describes each of these beliefs. According to Rabbi Bachaya, trusting in God necessitates subscribing faithfully to all six of the beliefs described above. Consequently, a lack of faith in any of the beliefs

26 25 constitutes a deficiency in Trust in God. Furthermore, Rabbi Bachaya s psychological theory hinges on his multi-faceted definition of Trust in God. As such, according to his theory, the general belief that God always takes care of human best interests is not sufficient to protect against worry and sadness; each of the six components of Trust in God is seen as essential to Trust in God and therefore to psychological health. Congruence with Cognitive Theory The hallmark of cognitive theory s view of mental health is the notion that beliefs and thoughts lie at the root of human emotion. According to cognitive theorists, emotional states are intrinsically linked to belief systems and the thoughts that arise from one s beliefs. In the words of Judith Beck (1995), In a specific situation, one s underlying beliefs influence one s perception, which is expressed by situation-specific automatic thoughts these thoughts, in turn, influence one s emotions (p. 17). All human beings have core beliefs about themselves and the world, which are used to interpret and understand the phenomena encountered. In a specific situation, these core beliefs automatically produce a set of thoughts, and these thoughts ultimately cause our emotions. For example, if a person believes he/she has poor social skills (e.g. that she has a tendency to appear awkward to people she doesn t know well), then if he/she finds him/herself in a situation in which she is meeting a group of new people, he/she will likely have thoughts that she looks strange or awkward to them. This set of thoughts will, in turn, produce a set of emotions, such as embarrassment and anxiety. See figure 1 for an illustration of the mechanics of this theory. Rabbi Bachaya s theory may be explained along the lines of the cognitive model. As described above, Rabbi Bachaya postulates that specific beliefs about God affect

27 26 one s emotional states. According to his theory, one who has Trust in God will remain calm and content even when faced with unpleasant situations. In other words, those who faithfully subscribe to all six beliefs which comprise Trust in God will have more pleasant emotional states than individuals who lack them. It is unlikely that fearful thoughts will originate from Trust in God. Rather, the beliefs associated with Trust in God will create cognitions which produce calmness and happiness, even in times of stress. For example, Robert has Trust in God and believes that God takes care of human best interests at all times and in all situations. If one finds him/herself in a situation which is uncomfortable (e.g. he is concerned about his social skills and he is meeting a group of new people for the first time), his/her cognitions will draw from his/her faith in God. He/she may think to himself, Although I am uncomfortable, I know that God put me in this situation and that there is a good reason for it, and therefore there s nothing to be nervous or scared about. This line of thinking will, in turn, produce a set of emotions, such as calmness and happiness. See figure 2 for an illustration of how Rabbi Bachaya s theory is congruent with cognitive theory. In both modern cognitive theory and Rabbi Bachaya s ancient Jewish perspective, affect is not seen as resulting directly from experiences and circumstances, rather internal perspectives are viewed to ultimately control emotionality. By way of core beliefs and cognitions, both theories can explain the origins of human affect. Specifically, both theories agree that all human beings have core beliefs which are used to interpret and understand the phenomena we encounter, and in a specific situation, these core beliefs automatically produce a set of thoughts, which cause our emotional states. The major difference between these two perspectives is the set of beliefs which are focused on as

28 27 salient. Cognitive theory generally highlights the importance of individuals beliefs about themselves (e.g. I am weak, I am a failure or I am unlovable ) and the world (e.g. it s difficult to make money these days ; people are mean ). In contrast, Rabbi Bachaya s theory is concerned with individuals beliefs about God (e.g. God is never ignorant of anyone s concerns, God is compassionate to human suffering ). The Present Study The past two decades have seen a resurgence of interest in the study of religion from a psychological perspective. Literature produced from psychological inquiries about religion has greatly aided our understanding of how religious life plays a role in human emotion and behavior. However, as noted above, there are a number of limitations to the current literature in this topic area. First, although there is strong support for an overall negative correlation between religious variables and depression, some studies have demonstrated that the relationship may not be linear. Second, regarding religion and anxiety, the current literature is essentially a mixed bag, with some studies indicating that religious beliefs and practices are helpful to those coping with anxiety and others demonstrating positive correlations between anxiety and religiousness. Third, most psychological studies on religion utilize single-item measures of religiousness and thus fail to consider the complexity of religious constructs. There is a need for greater specificity in defining and measuring religious constructs (Hackney and Sanders, 2003). Fourth, there are very few theoretical explanations for why religion may impact on depression and anxiety, and with the notable exception of Pargament s Religious Coping (1997) few explanatory models have been empirically validated.

29 28 Finally, very few studies have examined Jewish religiousness, and as a result our understanding of Jewish religious beliefs and practices is deficient, from a psychological perspective. To date, there has yet to be an empirical analysis of the relationship of religious Jewish beliefs to psychological variables among Orthodox Jews published in an APA journal. Furthermore, many general measures of religiousness are inappropriate for use with Orthodox Jewish populations, and therefore the potential for conducting future research with this religious group is limited. The present study addresses the limitations in the current literature in a number of ways. First, as stated above, the present study conducted an initial empirical investigation into an ancient Jewish theory about the etiology of anxiety and depression, as elucidated in the book Duties of the Heart by Rabbi Bachaya. Ancient as this theory is, Rabbi Bachaya s work provides a frame of reference to explain how a specific religious construct relates to psychological wellbeing. As such, the present study constitutes one of the first empirical inquiries into the validity of a theoretical model explaining the relationship between religiousness and anxiety/depression. While the correlational design of the present study cannot possibly validate Rabbi Bachaya s etiological model, it provides a framework from which future correlational and/or experimental investigations can be built. Second, the religious construct considered by the present study, Trust in God, is complex and specific. The definition of this construct and the creation of a psychometric self-report scale to aid in its measurement (the Trust in God Scale) is step towards examining the intricacy of religious variables in the course of psychological research. Finally, the present study is one of the first empirical inquiries to examine how Jewish religiousness is related to psychopathology, and thus it provides

30 29 some initial observations of how religious beliefs and practices play a role in psychological wellbeing among Jews. Method Participants A total of 567 individuals participated in the study, which involved the completion of an on-line questionnaire. Since the present study was concerned with religiousness among Jews, the responses of non-jewish participants were eliminated, yielding a total sample of 566 participants. Missing items were not replaced and so analyses were performed exclusively with responses from participants with complete response sets. There were more female (n = 328) than male (n = 237) participants; a single subject did not disclose gender. Participants ranged in age from 17 to 77 years. The mean age was years with a standard deviation of The median age was 33 years and the modal age was 26 years. Economic status, as measured by highest level of education, was elevated for the sample; 50.2% of respondents reported having masters/professional degrees and an additional 34.5% reported having a college diplomas or university degrees; only 3 participants (0.5% of the sample) reported not having graduated high school (see table 1). About 15% of the sample reported currently taking prescription medication to treat anxiety or depression. The sample was predominantly Modern Orthodox in its religious affiliation (46.8% of participants). However, the sample s religious affiliation was somewhat diverse, with 36% of participants being of non-orthodox affiliation, 19.3% of the sample reporting affiliation with the Conservative movement and 7.6% reporting Reform